Chesterton Academy Deposit Form

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  Parent's Information - Primary Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Primary Parent's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Additional Parent's Information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Street Address (if different from above) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Additional Parent's Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Religious Affiliation REQUIRED Please fill out this field.
  
  Current Parish Please enter valid data.
  
  Parish Location (City, state) Please enter valid data.
  
  How many students would you like to register? REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender REQUIRED Please fill out this field.
  
  Graduating year
  
  Current school, homeschooling, or combination REQUIRED Please fill out this field. Please enter valid data.
  
  Current school district of residence Please enter valid data.
  
  Does this student have a current 504 or IEP plan? REQUIRED Please fill out this field.
  
  Deposit200.0
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender REQUIRED Please fill out this field.
  
  Graduating year
  
  Current school, homeschooling, or combination REQUIRED Please fill out this field. Please enter valid data.
  
  Current school district of residence Please enter valid data.
  
  Does this student have a current 504 or IEP plan? REQUIRED Please fill out this field.
  
  Deposit200.0
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender REQUIRED Please fill out this field.
  
  Graduating year
  
  Current school, homeschooling, or combination REQUIRED Please fill out this field. Please enter valid data.
  
  Current school district of residence Please enter valid data.
  
  Does this student have a current 504 or IEP plan? REQUIRED Please fill out this field.
  
  Deposit200.0
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender REQUIRED Please fill out this field.
  
  Graduating year
  
  Current school, homeschooling, or combination REQUIRED Please fill out this field. Please enter valid data.
  
  Current school district of residence Please enter valid data.
  
  Does this student have a current 504 or IEP plan? REQUIRED Please fill out this field.
  
  Deposit200.0
  
  Student 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender REQUIRED Please fill out this field.
  
  Graduating year
  
  Current school, homeschooling, or combination REQUIRED Please fill out this field. Please enter valid data.
  
  Current school district of residence Please enter valid data.
  
  Does this student have a current 504 or IEP plan? REQUIRED Please fill out this field.
  
  Deposit200.0
  
  Student 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Gender REQUIRED Please fill out this field.
  
  Graduating year
  
  Current school, homeschooling, or combination REQUIRED Please fill out this field. Please enter valid data.
  
  Current school district of residence Please enter valid data.
  
  Does this student have a current 504 or IEP plan? REQUIRED Please fill out this field.
  
  Deposit200.0
  
  Preferred Location REQUIRED Please fill out this field.
  
  Thank you for your $200 enrollment deposit per student for the new Chesterton Academy in the Diocese of Portland. Please note that a full application process will be required before students are formally accepted into the school. If a student does not gain admission to Chesterton Academy, the enrollment deposit will be fully refunded
  
  Total:
  
  Submit
  
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